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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

How should we assess right ventricular function in 2008?

J.G. Coghlan1,* and J. Davar2

1 FRCP Department of Cardiology, Royal Free Hospital
2 MRCP Department of Cardiology, Royal Free Hospital

* Corresponding author. E-mail address: Gerry.Coghlan{at}royalfree.nhs.uk

The right ventricle is neglected in clinical practice, both because it is difficult to assess and because there is a lack of awareness of the pivotal role it plays in cardiac and pulmonary vascular diseases. Substantial progress is now being made and methods of assessing right ventricular function are beginning to be standardised and evaluated systematically in clinical studies. Clinicians need simple reproducible tests of right ventricular function to improve their management of pulmonary hypertension, carcinoid heart disease, congenital heart disease and left heart failure. Academics require robust methods of analysing the contribution of right ventricular myocardial failure to the clinical syndrome of cor-pulmonale and heart failure, so that the pathobiological processes can be resolved and optimal therapeutic approaches identified to support and improve right ventricular function in these conditions.

While awaiting such developments we must recognise that current measures in clinical usage (right atrial area, right ventricular diameters, change in fractional area and right ventricular ejection times) give helpful if incomplete information, and should form part of standard echocardiographic assessment. Clinicians should also be aware of the progress in the fields of wall stress and strain rate imaging as these may well be validated in the near future. MRI is already well recognised as the imaging technique of choice for right ventricular dysplasia and will certainly deliver to the clinician accurate assessment of right ventricular ejection fraction, mass and identification of areas of localised myocardial damage before long.

Key Words: End systolic elastance • Right ventricular wall stress • Mean normalised systolic ejection rate (MNSER) • Magnetic resonance imaging (MRI) • Combinable magnetic resonance (CMR) • Brain natriuetic peptide (BNP)


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